Report to Pacific Islands Medical Aid by Dr. Kent Saltonstall M.D.

This report describes my second and third medical assignments at London Hospital, Christmas Island, Republic of Kiribati, in the central Pacific Ocean.  As before I was very well received by Dr. Teraira Bangao, the anesthesiologist and hospital director, and Dr. Harry Tong, the full-time general surgeon.  These very experienced colleagues provide all the primary care on the island.  They have a good understanding of the people’s medical needs in relation to the resources available.

During my first assignment a year ago I was able to see dozens of patients for Orthopedic consultation, many with problems due to complications of diabetes.  Then in December 2011 I learned more about the very sick ones.  With Dr. Teraira’s skillful anesthesia assistance I operated on little Tavita, age six, for septic arthritis of the hip.  When I saw him again in May 2012 he was running about the place quite happy, and apparently cured of his infection.  In the interim, Dr. Harry had operated on a similar case, an older child who is cured also.  In December 2011 we evacuated to Fiji our boy Ruteti, paralyzed by some spinal illness that was never clearly diagnosed  at Fiji, nevertheless he was greatly improved on treatment for tuberculosis by the time I saw him again in May 2012.  Ruteti can now transfer and walk with support, and he is regaining bladder control.  I was a multidisciplinary team of one for this boy, providing hands-on physical therapy, bladder management, and corrective splinting.  Ruteti was my major effort on this third visit.  Our wonderful operating room nurse Kuuta will coordinate his care going forward, including advice to the family and reintegration into school and the traditional island society.  We think Ruteti is the only young paraplegic on the island.

My other project on this third visit was the beginning of a fracture treatment program, with generous material support from PIMA.  Enthusiastic staff will carry this forward in my absence, although at present hampered by lack of x-rays due to a chemical film development problem.

Other surgical projects for the island include upgrade of the operating room, in cooperation with a PIMA General Surgery and Anesthesia team.  A Gynecologic surgeon , Dr. Baranika Toromon, has been assigned by the Kiribati Ministry of Health to give the doctors much needed assistance in her specialty.  The government’s policy of rotating doctors among the Kiribati islands appears to be the best way of providing medical flexibility for a growing population.

Toward the end of my week at the hospital I learned from Dr. Teraira that I am the only Orthopedic Surgeon in the nation of Kiribati.

Respectfully Submitted,

Kent Saltonstall MD, Associate Clinical Professor of Orthopedic Surgery Emeritus, University of Washington Medical School, Seattle, Washington, USA.